Pertussis in Asia: Recent country-specific data and recommendations.

The Global Pertussis Initiative (GPI) Roundtable Meeting held in 2019, which preceded the COVID-19 pandemic, focused on the incidence, surveillance, and immunization practices for pertussis in the Asian region. Participants from China, India, Indonesia, Malaysia, Pakistan, Philippines, South Korea, Taiwan, and Thailand presented country-specific information on pertussis prevalence, diagnosis, surveillance, vaccine administration and schedules, maternal and neonatal disease rates, and policies and practice of vaccination during pregnancy. In recent years, many Asian countries have seen an increase in pertussis cases, although underreporting of the disease is a concern. Currently, most Asian countries have only passive surveillance for pertussis in place. There is a need for improved surveillance to determine the disease burden and justify vaccination policies and recommendations, such as essential vaccination, boosters, and vaccination during pregnancy. Better awareness of the disease in adolescents and adults is necessary, and infant and childhood vaccination schedules need to be improved in many countries. Differences between private versus public sector vaccination schedules and between whole-cell and acellular pertussis vaccines should continue to be examined. It can be anticipated that unmet needs in the prevention and management of pertussis will continue as the COVID-19 pandemic evolves and that key recommendations highlighted in this meeting report will be of ongoing importance.

Cholera in selected countries in Asia.

INTRODUCTION: Although the current pandemic of cholera originated in Asia, reports of cholera cases and outbreaks in the region are sparse. To provide a sub-regional assessment of cholera in South and Southeast Asia, we collated published and unpublished data from existing surveillance systems from Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam. METHODS: Data from existing country surveillance systems on diarrhea, acute watery diarrhea, suspected cholera and/or confirmed cholera in nine selected Asian countries (Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam) from 2011 to 2015 (or 2016, when available) were collated. We reviewed annual cholera reports from WHO and searched PubMed and/or ProMED to complement data, where information is not completely available. RESULTS: From 2011 to 2016, confirmed cholera cases were identified in at least one year of the 5- or 6-year period in the countries included. Surveillance for cholera exists in most countries, but cases are not always reported. India reported the most number of confirmed cases with a mean of 5964 cases annually. The mean number of cases per year in the Philippines, Pakistan, Bangladesh, Malaysia, Nepal and Thailand were 760, 592, 285, 264, 148 and 88, respectively. Cambodia and Vietnam reported 51 and 3 confirmed cholera cases in 2011, with no subsequent reported cases. DISCUSSION AND CONCLUSION: We present consolidated results of available surveillance in nine Asian countries and supplemented these with publication searches. There is paucity of readily accessible data on cholera in these countries. We highlight the continuing existence of the disease even in areas with improved sanitation and access to safe drinking water. Continued vigilance and improved surveillance in countries should be strongly encouraged.

Cholera prevention and control in Asian countries.

Cholera remains a major public health problem in many countries. Poor sanitation and inappropriate clean water supply, insufficient health literacy and community mobilization, absence of national plans and cross-border collaborations are major factors impeding optimal control of cholera in endemic countries. In March 2017, a group of experts from 10 Asian cholera-prone countries that belong to the Initiative against Diarrheal and Enteric Diseases in Africa and Asia (IDEA), together with representatives from the World Health Organization, the US National Institutes of Health, International Vaccine Institute, Agence de médecine préventive, NGOs (Save the Children) and UNICEF, met in Hanoi (Vietnam) to share progress in terms of prevention and control interventions on water, sanitation and hygiene (WASH), surveillance and oral cholera vaccine use. This paper reports on the country situation, gaps identified in terms of cholera prevention and control and strategic interventions to bridge these gaps.

Berberine protects against metformin-associated lactic acidosis in induced diabetes mellitus.

OBJECTIVES: Causality of occurrence of metformin-associated lactic acidosis (MALA) is a clinical problem. Currently, there is no drug available to prevent MALA. The present study was conducted to evaluate the protective effect of Berberine (BBR) against MALA in induced diabetic rat model. MATERIALS AND METHODS: A sample of 75 healthy male Wistar rats was randomly selected according to inclusion and exclusion criteria. 75 male Wistar rats were randomly divided into a control and 4 experimental groups. Streptozotocin (STZ) in citrate buffer (pH 4.5) at a dose of 45 mg/kg was injected for induction of diabetes mellitus and rats achieving fasting blood glucose >250 mg/dl were included. Blood samples were collected 18 hr after the last dose of metformin and berberine. Ethical approval was taken before the study was conducted. Staistix 10.0 (USA) software was used for data analysis. RESULTS: Berberine decreased MALA. Metformin, metformin + BBR 50 mg/kg bwt, and metformin + BBR 100 mg/kg bwt showed serum lactate as 1.87±0.4 mmol/lL, 1.62 ± 0.44 mmol/l and 1.47± 0.45 mmol/l, respectively (P=0.0001). Insulin resistance and liver enzymes were improved in BBR treated rats. CONCLUSION: The present study reports berberine protects against MALA in streptozocin-induced diabetes mellitus.

Frequency of anaemia in patients with systemic lupus erythematosus at tertiary care hospitals.

OBJECTIVE: To analyze the frequency and causes of anaemia in systemic lupus erythematosus (SLE) patients attending in department of medicine at tertiary care hospitals. METHODS: This retrospective, descriptive and analytical study was planned to analyze the frequency and causes of anaemia in SLE patients attending the department of medicine at (MMC) and (LUMHS) hospitals during the period of Jan 2006 to Nov 2008. The criteria used in this study were from the American College of Rheumatology. Investigations recorded were blood complete picture, absolute values, peripheral smear, and reticulocyte count in all patients of anaemia. These investigations were necessary to analyse the cases of anaemia in SLE. All investigations were not done in all cases. Patients with hypochromic microcytic anaemia were advised to have serum iron and ferritin levels, seven patients with macrocytic anaemia were advised to have direct and indirect coomb's test, LFTs, serum LDH, serum B12 and folate levels. Patients with normochromic and normocytic anaemia were considered to have anaemia of chronic disease. Bone marrow aspiration and Hb electrophoresis were done in two patients with anaemia of chronic disease. Thirty adult patients were included in this study. Special proforma were prepared to record the information from case sheets of patients including basic information, symptomatology and laboratory investigations. Severity and various types of anaemias were recorded. Anaemia was graded according to severity, as mild (Hb 10-12 G/dl), Moderate (Hb 8-10 G/dl) and severe (Hb < 8 G/dl). Haemoglobinopathies and other types of anaemias were excluded from study. RESULTS: Thirty adult diagnosed patients of SLE, were included. Their ages ranged from twenty years to fifty years at time of presentation. The mean age +/- SD (range) was 28 +/- 6.22 (20-50) years and median age was 31 years. Out of thirty patients, twenty seven (90%) were females and three (10%) were males. Twenty eight (93.33%) patients presented with anaemia, 14 (46.66%) patients were of mild anaemia, 8 (26.66%) patients were of moderate grade anaemia and 6 (20%) patients had severe anaemia. Iron deficiency anaemia was found in 9 (30%) patients, 12 (40%) patients had anaemia of chronic disease and 7 (23.33%) patients had haemolytic anaemia, out of theses 7 patients, 5 (16.66%) patients had Coomb's positive haemolytic anaemia. All thirty patients had ANA positive titres > 1:80; and nineteen (63.33%) patients had anti ds DNA positive, titres > 1:10. CONCLUSION: Haematologic abnormalities are common manifestations in patients with SLE. Most patients exhibit anaemia at some point during their disease course.

Multiple autoimmune syndrome: Hashimoto's thyroiditis, coeliac disease and systemic lupus erythematosus (SLE).

Various autoimmune diseases have association with each other but it is very rare to see multiple autoimmune diseases in one patient. Presence of more than two autoimmune diseases in one patient is known as multiple autoimmune syndrome (MAS). We report the case of an 11 years old girl who presented with history of swelling in front of the neck along with constipation, anorexia, weight gain and increasing pallor over a period of six months. Additionally she had an episodic history of joint pains and abdominal pain with no specific relation to diet, time, other gastrointestinal or genitourinary symptom. Hypothyroid goiter (Autoimmune thyroiditis, Hashimoto's thyroidits) was diagnosed by raised thyroid stimulating hormone (TSH), low T4 and presence of thyroid specific antibodies in blood. Patient was discharged on tablet Levothyroxine to which she responded well with reduction in size of the swelling and relief of the symptoms except for the joint pains and abdominal pain. To evaluate the persistent symptoms she was investigated further for other autoimmune diseases and was diagnosed to be having systemic lupus erythematosus (SLE) and Coeliac disease also. The final diagnosis was multiple autoimmune syndrome (Hashimoto's thyroiditis, Coeliac disease and SLE).

Serum zinc and magnesium in type-2 diabetic patients.

OBJECTIVE: To assess serum zinc and magnesium level in type-2 diabetic patients and the effect of age, gender, glycemic control and duration of diabetes on these trace elements in comparison with those of control subjects. STUDY DESIGN: Non-interventional case control study. PLACE AND DURATION OF STUDY: Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad, from October 2007 to March 2008. METHODOLOGY: There were 42 diabetic patients and 42 age matched non-diabetic (control) subjects included in this study. Serum zinc, serum magnesium and fasting blood sugar measured among the diabetic and control groups and association of both trace elements were assessed with glycemic status, age, gender and duration of diabetes using SPSS version 16.0 for analysis. RESULTS: Serum zinc level was significantly lower (mean 2.03 +/- 0.39 mg/dL) in diabetic patients as compared to control subjects (4.84 +/- 4.217 mg/dL, p = < 0.001). No significant difference was found in serum magnesium level with mean of 22.67 +/- 24.5 mg/dL in diabetic patients as compared to controls (18.3 +/- 3.4 mg/dL, p = 0.26). CONCLUSION: Serum zinc level was significantly lower in type-2 diabetics, whereas no significant difference was found in serum magnesium level when compared with control subjects. There was no association of age, gender, glycemic status and duration of diabetes on the serum concentration of these trace elements in type-2 diabetic patients.

Intestinal amoebiasis in children and its effect on nutritional status.

OBJECTIVE: To determine the frequency and clinical presentation of amoebic diarrhea in children and its effect on the nutritional status of the affected children. STUDY DESIGN: Descriptive. PLACE AND DURATION OF STUDY: Department of Diarrhea Treatment Unit (DTU), Dow Medical College and Civil Hospital, Karachi, from November 1998 to April 2001. METHODOLOGY: Paediatric patients between the ages of > 1 month to 15 years were included, who visited the DTU of the department with diarrhea. Stool samples of all these patients were checked under microscope for the vegetative forms of Entamoeba Histolytica (E.H.). Patients who were positive for E.H. were evaluated for the symtomatology including the type of diarrhea {acute watery diarrhea (AWD) or dysentery}, abdominal pain, tenesmus and nausea/vomiting. Examination carried out was assessed for state of hydration, fever and anaemia and nutritional status of those less than 5 years of age. The patients were divided into three age groups to assess the association of the age with severity and type of clinical presentation. Chi- square test was applied to calculate the p-values. P-values of 0.05 or less were considered statistically significant. RESULTS: The stool samples of 3870 patients with diarrhea were examined under microscope. Three hundred and twenty eight (8.47%) of these samples were positive for E.H. The difference between the number of patients presenting with acute watery diarrhea n=157, 47.86% and with dysentery n=171, 52.13% was found to be statistically non-significant (p=0.364). Two hundred and seventy seven (84.45%) patients had tenesmus, while abdominal pain was present in 287 (87.5%). Fever and malnutrition were present in 169 (51.52%) patients each. Malnutrition was significantly most frequent in 1-5 years of age groups (n=98, 57.98%, p=0.026). The nutritional evaluation of the 272 under-5 children with amoebic diarrhea showed a significantly normal status in 123 (45.55%, p-value < 0.001). All the signs and symptoms followed a similar trend with 1-5 years age group being the most affected group. However, the frequency of blood in stools increased in direct proportion to the increasing age. CONCLUSION: Although dysentery was the more common presenting complaint, almost half of the patients presented with watery diarrhea. Most of the patients with dysentery were under the age of 5 years. Fever was present in a high number of patients. The age group most affected by amoebiasis and malnutrition was 1-5 years.

Frequency of thyroid disorders during interferon and ribavirin therapy in chronic hepatitis C infection.

OBJECTIVE: The objective of this study was to assess the frequency of thyroid dysfunction in response to combination of interferon and ribavirin therapy in chronic hepatitis C (CHC) patients and HCV outcome. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: This study was conducted at Outpatient Department of Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad from September 2005 to September 2007. PATIENTS AND METHODS: One hundred cases of CHC, proven by anti-HCV and HCV RNA-positive with baseline TSH, FT4 and FT3 within the normal reference range, who were treated with interferon alpha-2b (3 million unit subcutaneously three times per week) and oral ribavirin (1000-1200 mg per day) were included in this study. All patients were assessed for TSH, FT4, FT3 levels at 12 weeks and 24 weeks during therapy. RESULTS: Among the 100 patients, overt thyroid disease developed in 13 (13%) and sub-clinical thyroid disease in 5 (5%). Out of 13 patients of overt thyroid disorders, 11 (84.6%) had hypothyroidism and 02 (15.3%) hyperthyroidism. Four (80%) patients were of sub-clinical hypothyroidism and 01 (20%) patient was of sub-clinical hyperthyroidism. Overall, thyroid disorders developed in 18 (18%) both as overt and sub-clinical thyroid disorders. Ninety one (91%) patients became negative by HCV RNA. CONCLUSION: Treatment of HCV with IFN-alpha and ribavirin can be safely continued in patients with over and sub clinical hypothyroidism because thyroid disease responds well to treatment.

Scleredema of Buschke in pediatric age group.

Two cases of scleredema of Buschke are described, which occurred in pediatric age group--an uncommon occurrence after febrile illness. Both cases were self-limiting. Characteristic features are described.